Provider Demographics
NPI:1740480219
Name:JARVIS, LISA U (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:U
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E WASHINGTON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3668
Mailing Address - Country:US
Mailing Address - Phone:423-333-7132
Mailing Address - Fax:
Practice Address - Street 1:130 E WASHINGTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3668
Practice Address - Country:US
Practice Address - Phone:423-333-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6590101YP2500X
TN1695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1695OtherTN LICENSE NUMBER